There is, however, one form of obstruction still available to the G.O.P.
Last year’s Supreme Court decision upholding the law’s constitutionality
also gave states the right to opt out of one piece of the plan, a federally
financed expansion of Medicaid. Sure enough, a number of
Republican-dominated states seem set to reject Medicaid expansion, at least
at first.

And why would they do this? ... The ... only way to understand the refusal to expand Medicaid is as an act
of sheer spite. And the cost of that spite won’t just come in the form of
lost dollars; it will also come in the form of gratuitous hardship for some
of our most vulnerable citizens. ...

A new study from the RAND Corporation ... examines the consequences if 14
states whose governors have declared their opposition to Medicaid expansion
do, in fact, reject the expansion. The result ... would be a huge financial
hit: the rejectionist states would lose more than $8 billion a year in
federal aid, and would also find themselves on the hook for roughly $1
billion more to cover the losses hospitals incur when treating the
uninsured.

Meanwhile, Medicaid rejectionism will deny health coverage to roughly 3.6
million Americans, with essentially all of the victims living near or below
the poverty line. And since past experience shows that Medicaid expansion is
associated with significant declines in mortality, this would mean a lot of
avoidable deaths: about 19,000 a year, the study estimated.

Just think about this... It’s one thing when politicians refuse
to spend money helping the poor and vulnerable; that’s just business as
usual. But here we have a case in which politicians are, in effect, spending
large sums, in the form of rejected aid, not to help the poor but to hurt
them.

And ... it doesn’t even make sense as cynical politics. ... What it might do
... is drive home to lower-income voters — many of them nonwhite — just how
little the G.O.P. cares about their well-being, and reinforce the already
strong Democratic advantage among Latinos, in particular.

Rationally, in other words, Republicans should accept defeat on health care,
at least for now, and move on. Instead, however, their spitefulness appears
to override all other considerations. And millions of Americans will pay the
price.

There is, however, one form of obstruction still available to the G.O.P.
Last year’s Supreme Court decision upholding the law’s constitutionality
also gave states the right to opt out of one piece of the plan, a federally
financed expansion of Medicaid. Sure enough, a number of
Republican-dominated states seem set to reject Medicaid expansion, at least
at first.

And why would they do this? ... The ... only way to understand the refusal to expand Medicaid is as an act
of sheer spite. And the cost of that spite won’t just come in the form of
lost dollars; it will also come in the form of gratuitous hardship for some
of our most vulnerable citizens. ...

A new study from the RAND Corporation ... examines the consequences if 14
states whose governors have declared their opposition to Medicaid expansion
do, in fact, reject the expansion. The result ... would be a huge financial
hit: the rejectionist states would lose more than $8 billion a year in
federal aid, and would also find themselves on the hook for roughly $1
billion more to cover the losses hospitals incur when treating the
uninsured.

Meanwhile, Medicaid rejectionism will deny health coverage to roughly 3.6
million Americans, with essentially all of the victims living near or below
the poverty line. And since past experience shows that Medicaid expansion is
associated with significant declines in mortality, this would mean a lot of
avoidable deaths: about 19,000 a year, the study estimated.

Just think about this... It’s one thing when politicians refuse
to spend money helping the poor and vulnerable; that’s just business as
usual. But here we have a case in which politicians are, in effect, spending
large sums, in the form of rejected aid, not to help the poor but to hurt
them.

And ... it doesn’t even make sense as cynical politics. ... What it might do
... is drive home to lower-income voters — many of them nonwhite — just how
little the G.O.P. cares about their well-being, and reinforce the already
strong Democratic advantage among Latinos, in particular.

Rationally, in other words, Republicans should accept defeat on health care,
at least for now, and move on. Instead, however, their spitefulness appears
to override all other considerations. And millions of Americans will pay the
price.